Project Summary/Abstract The long-term objective of this proposal is to increase the accessibility and affordability of hearing loss treatment for older adults with hearing loss and mild cognitive impairment (MCI) or Alzheimer?s disease and related dementias (ADRD) by improving our knowledge base of speech perception abilities in this population and directly translating that knowledge into a tailored approach to hearing intervention. Age-related hearing loss (ARHL) in persons with MCI or dementia may exacerbate dementia-related symptoms such as depression, apathy, agitation/aggression. Moreover, engagement and activity participation are recognized as critical aspects of dementia care management, but those individuals who also experience ARHL are at a disadvantage. The aims of this proposal include basic science investigation as well as refinement and pilot testing of a behavioral communication intervention. Aim 1 will focus on controlled laboratory measures of speech perception abilities in complex background noise as well as the ability to benefit from common communication repair strategies in groups of older adults with MCI/early stage dementia and older adults matched with these individuals for age and hearing thresholds. This aim will improve our theoretical understanding of speech perception abilities for older adults with cognitive impairment. The investigations undertaken in Aim 2 will focus on assessing and defining the functional burden of ARHL and cognitive impairment in group care settings for older adults. A mixed methods approach will be undertaken in Aim 2 to better understand how the quantitative aspects of the prevalence of ARHL and cognitive impairment interact with the acoustic environment as well as the behavioral/social context of staff and peer interactions in the group care setting. Finally, the multicomponent hearing care intervention to be tested in Aim 3 includes acoustic modifications, staff training, and non-custom personal amplification use with target individuals in a group care setting. This feasibility study will lead to the refinement of the intervention protocols to be used in a future grant application that will test the real-world efficacy of the intervention in a cluster- randomized control trial. Dr. Sara Mamo is a tenure-track Assistant Professor in the Department of Communication Disorders in the School of Public Health and Health Sciences at the University of Massachusetts Amherst. With this Mentored Patient-Oriented Research Career Development Award, Dr. Mamo intends to develop methodological skills related to testing speech perception and improve her knowledge base in the theoretical underpinnings of behavioral interventions, the evidence-based approaches to clinical management of dementia, and statistical analyses of longitudinal outcomes. These key training components will support the development of a hearing care intervention that can be integrated into comprehensive care of older adults with cognitive impairment, and measure the long-term downstream effects associated with the intervention in future randomized trials.